title: Knowledge, attitude and perceptions of breast cancer screening among native and immigrant women in Barcelona, Spain.
abstract: OBJECTIVE
  Inequalities between immigrant and native populations in terms of access and use of health services have been described. The objective is to compare knowledge, attitudes, vulnerabilities, benefits and barriers related to breast cancer (BC) and screening mammography among women from different countries resident in Barcelona.
  
  
  METHODS
  A cross-sectional survey carried out in Barcelona in 2009. The study population consisted of female residents in Barcelona between 45 and 69 years of age; participants were Spanish nationals or immigrants from low-income countries. 960 participants were asked 72 questions, mainly with Likert responses. The dependent variables were five quantitative scales: (1) knowledge of BC and early detection, (2) attitude towards health and BC, (3) vulnerability to BC, (4) barriers to mammography, (5) benefits of mammography. The independent variables were country of origin, social class, setting, cohabitation, age, mammography use, length of residence and fluency of the language. Analyses compared scale scores stratified by the independent variables. Multivariable linear regression models were fitted to determine the relationship between the scales and the independent variables.
  
  
  RESULTS
  We observed inequalities according to country of origin on all scales after adjustment for independent variables. Chinese women presented the greatest differences with respect to native women, followed by Maghrebi and Filipino women. Inequalities exist on the vulnerability and barriers scales according to social class and urban/rural setting, and on the attitude scale according to social class.
  
  
  CONCLUSIONS
  Country of origin, social class and urban/rural setting are key contributors to inequality in these scales.
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. mvigues@aspb.cat
authors.forename: Mariona
authors.initials: M
authors.lastname: Pons-Vigués
authors.forename: Rosa
authors.initials: R
authors.lastname: Puigpinós-Riera
authors.forename: Gemma
authors.initials: G
authors.lastname: Serral
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Pasarín
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez
authors.forename: Glòria
authors.initials: G
authors.lastname: Pérez
authors.forename: Josep
authors.initials: J
authors.lastname: Benet
authors.forename: Montserrat
authors.initials: M
authors.lastname: Casamitjana
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010465:Perception; D011203:Poverty; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D013030:Spain; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data